Q&A: Sen. Manka Dhingra on behavioral health


Aaron Kunkler


Sen. Manka Dhingra (D-45th) chairs the Senate Behavioral Health Subcommittee, serves as vice chair of the Senate Law and Justice Committee, and sits on the Ways and Means Committee. During her time in the legislature, Sen. Dhingra has advocated for behavioral health bills, support for domestic violence survivors, and for gun safety.

More information from this interview on non-health care bills can be found at the Washington State Wire, our sister site. 


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Aaron Kunkler: With the 2022 legislative session approaching, what are your policy priorities?

Sen. Manka Dhingra: This is a short session. I also think that myself and a lot of legislators, a lot of the public, are just fairly exhausted. So I don’t expect any huge large bills or new ideas or concepts. I think a lot of the work is a refining of the work we’ve been doing, making tweaks as needed and perfecting or improving the system of governance. Because, frankly, the last four years since I won and we took over the majority there has been just tremendous change in terms of putting people first, making sure people have access to services and support. 

We had the big domestic violence bill last session, where really, again, Washington is leading the country in the way we’re providing services and support to survivors of domestic violence, sexual assault, and stalking. And we have the issue with coercive controls peeking out at the last minute in the Senate. So there’ll be a bill about making sure we are putting back in. I know our office has been contacted a lot since the Maid came out on Netflix, because it’s all about coercive control in Washington State. And now, there’s no protection for that in our state. 

We’re definitely gonna see that. I in fact actually have a town hall tomorrow on domestic violence, talking about barriers and how we can streamline the system for survivors, because we saw a 30% increase in fatalities for survivors of domestic violence. I mean, a lot of the murders that we saw this year, last year, were, unfortunately domestic violence. 

Behavior help is going to be huge, and the workforce. We did record investment in behavioral health this last session, both substance use disorder and mental health. A lot of those grant dollars for these programs haven’t been used, because agencies are saying they don’t have the workforce for it. Which is really unfortunate, because people have been wanting these dollars for such a long time. And now when they’re finally there, they don’t have the workforce. So really taking a look at that. And take a look at not just behavioral health workforce, I think you can include all healthcare providers in there, because they have really been stressed for the last year and a half.

AK: On the workforce issue, what are some specific pieces of legislation you’re considering, or ways the state could help?

MD: So you know, a lot of making sure we’re using peers more within the system. So certified peers right now in our state, you can only use them if they work with an agency. So anyone who has private insurance does not have access to peers. And there’s a lot that they can do in terms of care coordination, doing that connection with individuals, and making sure they stay in treatment, or do that first introduction to treatments. I think there’s a lot of opportunities to create those pathways for certified peers to provide more of these services. The last few years, in my opinion, the health bills, I’ve been putting in care coordination requiring that. This really is a subset of people who can really help with that component.

There is a program out of the UK that has been really effective. It’s called a behavioral health support specialist, and it’s a bachelor’s level degree. And it’s something that the University of Washington has been very interested in as well. So I’ll be doing a bill about making sure we have that in our spectrum of professionals. Because there’s so much work that that master’s level clinicians do that’s administrative. If they have those behavior health support specialists there’s a good way for them to kind of divide that workload. 

I know there’s a lot of interest in doing loan repayment, doing a lot of other structures around how to make sure we’re attracting people into the field. And then I know there are ideas around how to keep people in the field once you’re in the field. Retention is a huge component as well, people really get burnt out. So during assembly days and have a health subcommittee will actually be doing a work session on workforce and the recommendations that are coming out of different groups. 

…Then again, making sure we have apprenticeship programs, really taking a look at CDP, the chemical dependency professional license, and the MHB, the mental health professional license, to see how we can just make sure we are not unnecessarily creating barriers for getting those.

AK: Definitely. It seems like the state is really interested in expanding apprenticeship opportunities in fields where they haven’t been a traditional pathway. 

MD: Yes, absolutely. I think we just don’t use them as much as other countries and other states do. I’m really glad that we are leaning into that. Traditionally, people say no, apprenticeship means when you’re doing work with your hands. It could be a plumber, or an electrician, but that’s not true at all. You have apprenticeships that you can do for all professionals all the time. In my district, we have the Tesla STEM school. We just call them internships when you do it in an office but it’s the same thing. But you can formalize a lot of that work. And that’s really the best way to recruit people into a profession is to provide them that opportunity earlier on. 

The other big behavioral health bill that I’m going to have is on assisted outpatient treatment. Right now in our state, the way it works is that it’s an option that’s available to you after hospitalization. I want to take it and make it an option prior to hospitalization. That is what is done in a lot of other states, and that is in fact what the model recommendation is from the Treatment Advocacy Center. And so it’ll basically say that you can seek assisted outpatient treatment prior to the need of hospitalization so you can provide those services and support. So it’s the same thing we’ve been doing in the last three years where we’re kind of pulling back on when you provide services so that it’s as early on in the process as possible, instead of waiting for that crisis to occur. 

In our state, it’s the excellent DCR, the designated crisis responders, who filed the petition, which is a very unique situation, other states don’t have that concept. If assisted outpatient treatment were actually going to expand that to say a DCR can do the petition like they normally do, or someone who already has a treatment relationship with the individual. So a person who’s already getting treatment and their provider can see them decompensating and they know that they’re headed to hospitalization, they can intervene and say ‘Hey, can we do this because we know this person is going to end up hospitalized if they don’t get this help.’ 

So we’re expanding that because we know DCRs are completely overworked. When that system was created in Washington, I think there were concerns about misuse, or someone manipulating the system, but our standards are so high, and they still require court action. So I’m very excited about that component, because I really do want to see how it’s going to work. 

AK: You mentioned that this session will mostly be focused on refining bills that have recently passed. What bills are you thinking of?

MD: The long-term care act is definitely on the list. And, you know, there’s an advisory committee that was created as part of it to give recommendations. I think those recommendations are due next month. So I think that’s definitely on the list of things that we need to be working on. I’m sure there’ll be more to be done in the housing situation. 

I’ll tell you one other thing on health care that I’m interested in. I’ll have a bill on breast milk equity. This is for preemies and infants in our NICU. They’re given a lot of medications, but really, one of the things that would be great is if our doctors could just prescribe breast milk and bill for it. And we have a few states around the country that do that. And we’re looking at the New York model, and a bill on that. It really is the best for infants and preemies and I think we have donor breast milk. So really making sure that our health care providers actually can prescribe breast milk, instead of a lot of the other medications that are needed to stabilize our very, very tiny Washingtonians.